The 3 Day Medicare Rule That You NEED To Understand

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Most people don’t learn this Medicare rule until it’s too late.

It’s called the 3-day rule.

And misunderstanding it can change what Medicare will, and will not, help pay for after a hospital stay.

Today on the Medicare Daily Show, Marvin is breaking down the rule every beneficiary needs to know before they’re the one dealing with it.

Transcript

SPEAKER_05 0:03

If you're on Medicare or looking into Medicare, you have already learned that there's lots and lots of rules. Uh we have rules to get into Medicare, we have rules to buy insurance plans, uh, and we also have rules for actually using our Medicare coverage. And today we're gonna show you a rule that many people are not aware of that is probably gonna impact your life one time or another. And this is a rule that most people are not aware of, but it is very important as it relates, especially to rehabilitation in a skilled nursing facility. I'm joined in the studio today with uh one of our top agents, Ethan Salvino. Ethan, good to have you today. And uh we are gonna talk with you today about uh this rule that matters. It's a rule that uh we don't want you to be caught off guard, and so we'll get in all the details of that. Uh if you'd like to call in uh today and uh have ask us a question about Medicare, about Social Security, uh really about anything retirement related, we'd love to hear from you. Let me give you their show number. If you call in, it's 833-824-2004. Again, 833-824-2004. Now, I also want to give you one other number because sometimes people would like to speak to an agent. So don't call the show for that. If you want to speak to an agent directly today, we have agents uh available. Uh we're open to uh this evening until 7 p.m. Central Time. And so you can reach us at 800-782-6676. Again, that comes into our switchboard. Uh, we can transfer you to an agent that I know personally and that has been trained uh, of course, by me, uh, and we'd be thrilled to uh serve you in any way. So again, the call-in show is 833-8224-2004. We'd love to hear from you, uh especially those of you that um uh are uh experiencing something. I mean, we'd love to hear stories because a lot of things happen in the Medicare world and we love to hear uh what's happening to you. All right, as we look at uh this very important rule, uh I want to clarify to make sure that you understand what we're addressing in this rule has to do with skilled nursing facilities. Skilled nursing facilities uh are a place, of course, where people go uh for fairly intensive rehab. It could be after a stroke, it could be after a hip replacement, uh, could be after a very serious illness. Um so we go to skilled nursing facilities typically for uh physical therapy, occupational therapy, speech therapy, a variety of reasons. And so skilled nursing facilities uh are typically actually within uh a long-term care facility, uh, but they're designed uh uh for rehab. Uh and so it's a very high likelihood that you'll recover, so you go into a skilled nursing facility. And so what happens is this Medicare has a rule that says that if you are going to be admitted to a skilled nursing facility, uh you must be in a hospital for three days or longer prior to the doctor admitting you to the skilled nursing facility. Now, the key to this is uh these are actually admitted days, meaning you have been in the uh admitted. Uh observation does not count uh towards this three-day rule. So once we have been admitted, now we need to be in three midnights. Uh so if I were to go in uh and be admitted to the hospital, let's say on a Tuesday afternoon, uh Tuesday night, Wednesday night, Thursday night, I have got to be sleeping in the hospital, and then uh uh the next day, uh then they could put me on that Friday. They could put me into a skilled nursing facility, and then I qualify for the three midnights. And so what that means then, because I was in three full midnights or longer, uh then Medicare will cover all the expenses in the skilled nursing facility uh for the first 20 days. It literally doesn't cost you a penny first twenty days. Now, if you are only in two midnights, Medicare is not gonna pay a penny. All right. So that's why this rule is so important. Now keep in mind if you're on advantage plans, a lot of the advantage plans will waive the rule because they don't want you in the hospital very long. They're gonna get you out there as soon as possible. Uh and so uh just be mindful of that particular rule. But if you are in original Medicare, got a submetal plan, that's why they keep people uh the three full days before admitting you then to the skilled nursing facility. So it's a very important rule. And I want to clarify just a couple things. One I already said, and that is that days of observation do not count. So sometimes people go in the emergency room uh and uh uh they can't be discharged. They actually put them under observation for a couple days uh and do not admit them, and then they want to put them in a skilled nursing facility. That's not going to work. Observation days do not count. Again, we have got to be admitted. The other thing that is critical about this is uh this is for rehab. This is not for custodial care. Uh so many people uh are not aware that um uh Medicare does not cover custodial care. Custodial care means that you need assistance with bathing or dressing or eating or toileting or transferring from your wheelchair into the bed or to uh uh onto the stool. Those kind of things are activities of daily living, and uh it is a nursing home that covers those custodial uh needs. It is not Medicare that is going to cover that. So this is rehab, high likelihood of recovery. Another thing about this is that once we have been in a skilled nursing facility, and again we qualified with the three midnights now. Uh if we're still in a skilled nursing facility, Medicare still covers us, but we will have a small daily copay. But this whole period of time, Medicare will cover you up to a hundred days. First 20 is on them uh because of the midnight rule, three midnight rule, and then after that we'll have a daily copay. But let's say you're you're discharged and everything is fine, and you know, two years later you have a hip replacement and you need to go back in, no problem. So those hundred days is not a lifetime, it's actually tied to a benefit period. All right? And so if you're on a supplemental plan, uh I want you to know that uh as long as we've had the three-day rule, uh, then that copay that you are responsible for will actually be covered by your supplemental plan. Most of you are on a G plan or an N plan, it will cover it fully. So as long as we have been in uh the hospital three midnights or longer, there will be no out-of-pocket expense for you at all for the first uh hundred days uh in that skilled nursing facility. All right, so that's why this three month uh midnight rule is so important. All right, let's go to Marilyn in Nebraska. Marilyn, welcome to Medicare School Daily. Appreciate you calling in. Uh, what kind of questions do you have? Or uh what do you want to discuss today with us?

SPEAKER_02 6:11

Hello, thank you for taking my call. You're welcome. I'm calling because I have had uh Medicare Advantage Plan since I was 65. I'm 76 now. It's been a long time. I really dislike the ad advantage plans. And um I would like to know whether or not I can switch back at this point in my life when October comes.

SPEAKER_05 6:40

All right. Well, we'll address that, Ethan. I'm gonna let you tackle it, sir. Let's let's talk with Marilyn.

SPEAKER_00 6:44

So, Marilyn, with switching from a Medicare Advantage plan to a Medicare supplemental plan, you're always given the option to October 15th through December 7th, that annual enrollment period. However, you would have to medically qualify. Typically, insurance companies are gonna screen you, uh, 30 to 40 health questions. There's no physical to go into a doctor for. Um, Marilyn, if you don't mind me asking, uh, how does your health look?

SPEAKER_02 7:09

Well, I've lost a lot of weight. I was diabetic and had the high blood pressure and everything, but now my um I'm no longer on blood pressure medication, and my diabetes, an A1C, is 3.2, which is great. But that's a lot of medication called Ponjaro, okay? Which I take. I take uh a micro dose basically once a month instead of taking it for every week, like most people take it a very small amount of it.

SPEAKER_05 7:47

Let me ask you a quick question. What is the what's the worst thing in your your uh medical situation right now or in the last couple years? What's the worst thing? If anything, uh there isn't really good. So just diabetes, and that's it.

SPEAKER_02 8:05

Yeah, basically diabetes. I mean I've I've had I've had many kidney stones and I've had to be in a hospital for that.

SPEAKER_05 8:15

Well they're painful, but that that won't keep him from getting a med supplant, so we're sorry to hear that. So you're just a a type two diabetic, uh taking uh some meds for that, which is all fine. Uh so nothing heart, uh liver, lung related, no COPD, emphysema, uh things like that. Nothing? No. Okay, that sounds good.

SPEAKER_02 8:37

I have had um pneumonia and uh just they always are asking me if I've ever had COPD and all that, but uh no, I've never had any anything uh like that.

SPEAKER_05 8:52

All right. Well, based upon what you're telling us, uh very, very probable that you can get switched later this year. So why don't you give her some prices, Ethan? Let us tell you what the market is right now. Now here's here's here's the bottom line. Uh you are gonna have to be on that advantage plan uh because I don't think there's anything we can do now. Yeah, nothing now. So you're gonna have to be on it through this year, but you can get on uh a supplemental plan, a great one, uh, effective one one. And Ethan would be happy to help you with that uh later this year. Marilyn, we can do that for you. Uh so he's gonna give you some prices. Now, do you know the differences between uh the two top supplemental plans right now? Are you familiar with them?

SPEAKER_02 9:30

No, because they were never explained to me when I was 65 that that the cost, all I knew is that the cost with a supplemental plan was going to be a lot more than the advantage plan, and they made it sound like it would be, you know, of course much more to my advantage to be on an advantage plan.

SPEAKER_05 9:49

Well, we know that's not true as to their advantage because uh we make more money on advantage plan sales. But uh that yeah, anyway, you don't have better coverage. But uh there will be a premium. He's gonna give you those prices. So again, October 15th to December 7th, uh, we can make this move for you. Uh we'll make sure you're on the right drug plan and it goes into effect one. So go ahead, Ethan. Tell her tell her what kind of rates and then explain to her. And also, and he's gonna tell you the difference between GNE and you'll have to summarize it because we can't go uh yeah too much longer here on our program. We're just about over. But uh I would encourage you, if you don't mind, you can go to our website, which is called Medicare School.com. MedicareSchool.com, and we have uh uh it's a called Essentials Workshop. It's a free workshop. It's about 50 minutes long, and I promise you it will go over everything you need to know to really be confident in your decision. So MedicareSchool.com, you can't miss the button, it's right on the homepage that says uh uh free workshop. So you can do that. But go ahead, explain to her difference, yeah, uh kind of summarize between G and N. Because it really boils down to premium and and the coverage, it's a little bit different. Go ahead.

SPEAKER_00 10:53

Yeah, so Marilyn, with whether you choose a plan G or plan N, uh two things are the same. Number one, you have to continue to pay that 2029 that's coming out of your social. That's water under the bridge, regardless of who you're with. And also, these are gonna have no referrals, no pre-approvals, no networks. You get open access. Now, if you choose a plan G, this is gonna be the Cadillac coverage, if you will. The highest um form of coverage that's the most cost effective at the moment. Uh-huh. You'll have a deductible of 283. What the means for you is you spend 100% of your medical bills until you hit 283 out of your pocket yearly. That's one doctor's office visit nowadays, how expensive it gets. Once you meet that, Medicare covers 80%, and your supplement G covers the remaining 20% balance. So that's the G. 283 is your worst case scenario. For the year. For the year. That's what I'm on, by the way. Go ahead. Yeah. And then plan N is going to be one step down in coverage, Maryland, uh, which means that it's going to be a step down in price, which we'll get into. You have that same deductible of $283. Once you meet that, Medicare covers 80%, supplement N covers the remaining 20%. But then you have two copays that you should be on the lookout for. It's $20 for a doctor's office visit. That's primary or specialist. The specialists do not upcharge. And then $50 for an emergency room visit. Now that's if you are in the emergency room and discharge from the emergency room. If you're put into the hospital after that's waived, neither here nor there. But there's one more liability, Marilyn, on the Plan N, and that's the physician's excess charge. Roughly 2% of doctors around the nation can charge an excess of 15% to the Medicare approved amount, and you'd be liable for that on the plan N. Now, this is what both of my grandparents have right now. They've had it for about 20 years, Marilyn. Never once had they mentioned an excess charge because all you got to do is ask. Call the doctor, do you charge excess? If they say yes, find a new doctor. Pretty easy to avoid. Not many doctors actually charge it. But looking in the prices, if you're going to go with the highest form of coverage at Plan G, we're looking roughly in the ballpark of $215 a month. $215. $215. Okay. $215 a month on that on that G plan. Given you qualify. And in the plan N, uh typically about $50 less, we're looking about $150, $260 on a monthly basis.

SPEAKER_05 13:14

All right. So about one we'll just call $155. Keep it simple. So that's the range. Depending upon the carrier that we would go with. So $215 a month for your G and then $155 for your N. So you're going to save about $60. But on that G plan, why I went with it is because once a year I meet a small deductible, it's $283 this year, and that resets every year, but that's all you're out of pocket. So you truly have 100% coverage after the deductible is met. But the N is still good. It is. Lots of people get it, a little more budget friendly. Um got a couple copies, of course. Doesn't cover excess, which is rare anyway. So either one truly would would would be great for you. Now one thing we haven't talked about uh, you know, as far as pricing, because we we don't have time right now, but you do have to have a drug plan. Your advantage plan has an embedded drug plan. So we'd have a separate drug plan, we'd help you pick that out. They're all very reasonable, minus ten bucks a month. You know, so uh that'd be something else that would be in addition. But here's the thing. Listen, Maryland, right now, uh you have a max out-of-pocket liability on your advantage plan. They average is about $5,900. You know, yours may be four or five grand, could be ten or twelve thousand. Uh but the point is you're gonna pay either way. The advantage plan you pay as you go, submodal plans you pay a premium and you're pretty well done. And so um both are all right systems. We just l tend to lean towards ad uh SUPS because no networks. Uh uh Ethan mentioned this. Go to any doctor you want. You don't have to worry about what that insurance company uh network uh has offered you. Uh plus the insurance company has no say so about anything that happens. If Medicare covers, stop metal plan also covers. So just the ease of use is just awesome when it comes to uh stop metal plans. I'm not trying to talk you into it. I'm just trying to tell you uh there are a lot of people that are very disappointed with their advantage once they realize how they're actually going to work. Agents push them because we get twice the commission, uh, so it's very advantageous for the agent to talk about how great they are. But I can't couldn't say that uh uh the insurance is is that is that great, really. It's it's all right for routine, simple stuff, but when you get into complex issues, uh it can be very problematic.

SPEAKER_02 15:21

That all that is. But now that I'm getting older, it it does make sense. But now that I'm getting older, your chances of falling, breaking a hip, uh having a stroke, all those things increase. And in your previous program, you said something about the fact that um they don't in skilled nursing facilities, they may not the advantage plans may not give you the number of days you need to recuperate for such things.

SPEAKER_05 15:46

Yeah, absolutely. And you may not be able to be able to find someone who's gonna take it. We run into that all the time now. Uh there may be, you know, five, six, seven uh skilled nursing facilities in your area, and hopefully you can find one to take your plan. Very common problem today. And you know why? Because advanced plans don't don't pay the skilled nursing facilities enough to cover uh the cost of care. They uh Marilyn, I've I've I've met several uh administrators of skilled nursing facilities, and they say we do we we lose money usually. Um that's why most of them don't take it any longer. They just don't get paid enough. Alrighty? Now Marilyn, we're gonna let you go, but I was gonna mention something. If you would like, and there's no pressure, so please understand my even my motive in this, if you want Ethan to reach out to you later this year, because again, we can't do anything right now, but if you want him to, uh we have your your phone number. He'd be happy to reach out to you and get you on the calendar uh between October 15th and December 7th. And we'll we'll we'll hold your hand and walk you through this process to make sure you know what you're doing. And uh it's your call, uh, but we'd be happy to serve as your broker if you would like. What would you you want us to reach out to? Ethan. Ethan is all Ethan Salvino. Yeah. So and he'll reach out to you sometime probably in September to get you on the calendar for after because we we can't do anything until after the 15th of October. But he'll put you, he'll reach out to you, get you on the calendar, and we'll we'll take care of you, okay? Thank you so much. You're welcome. Okay, he'll he'll get he'll give you a call soon and get get that on the calendar. Okay, thank you very much. Take care, Marilyn. We'll see ya. Bye-bye. All right, we have Jim in Minnesota. Jim, welcome to the program, sir. Uh appreciate you calling in today. Uh, how can we be of help to you?

SPEAKER_01 17:30

Sure, Marlon. Um, just the basic information is that my wife and I are both teachers, and we're on we're on uh the school district um insurance plan. And uh we're she's 65. I'm gonna be 66 this fall. I'm 64 and a half, right at the place where I could be on Medicare.

SPEAKER_05 17:56

Are you both still working? Just to make sure I'm clear. Are you both working?

SPEAKER_01 18:00

We're both still working. Yes. Go ahead, keep going. And we're on and we're on our you know, school district's insurance plan. But they made some changes this last year. We've had teacher married to teacher, which was a tremendous benefit. Um, but they are in a process of doing away with that benefit. And for right now, our premiums are low enough, but we're also looking at you know deductibles of between the two of us $7,000, $3,500 a piece. And we have money tied up that we've set aside that we have to either use or lose. Um, I think it's an HRA. I'm not exactly sure what you call that account.

SPEAKER_05 18:43

It's either an HRA or it could be a flexible spending account, F S A. It's flex flex, it's flexible.

SPEAKER_01 18:49

Okay. That's what it is. But one of the other flies in the ointment is that we we adopted uh a baby uh late. My son was on the way out, uh, senior year of high school, and um and we adopted my daughter, who's now 17, so we have to take care of her as well. So I guess the crux of my question is that as we're weighing through this, um we're we're trying to decide do we stay until we're both 67? She'll get there a little sooner than me. Um paying that two to only 214 a month for a premium, but having those deductibles and not being happy with, we're having to haggle with our insurance company. We're still getting bills, and our deductibles should have been covered, and it's a real hassle. Um we're not happy with what we're doing.

SPEAKER_05 19:45

Hey Jim, is that 214 each or 214 total?

SPEAKER_01 19:49

Total. 107 each. So it's very affordable. Yeah.

SPEAKER_05 19:53

That's pretty low.

SPEAKER_01 19:54

Very affordable for the same.

SPEAKER_05 19:55

Now, do you all let me ask you this now? Do you all uh ever ever meet your deductible?

SPEAKER_01 19:59

You said it, I think you said it was about Yeah, yeah. We have we have um both have some ongoing medical issues. I'm type 2 diabetic, um, and amonostatin. Um although both those both those things, my cholesterol and my diabetes, have been well controlled for a long time with just the meds. So um Hey Jim, let me know this.

SPEAKER_05 20:26

Do you know if the district uh would let you drop that plant at any time that you want, or is there a certain uh time of the year you can do that?

SPEAKER_01 20:34

We have a window that we have to have to meet.

SPEAKER_05 20:39

What what is that window? I think it's like October 1st. Okay, that sounds good. Do us a favor. Let's let's look at some rate real quickly. The numbers we're gonna give you, Jim, will be close, okay? They'll be sure at least you give you good enough information you can feel like is this something you want to consider um uh you know at the right time when the company will let you go. He's gonna give those to you in just a second.

SPEAKER_00 21:03

Yeah, we're looking on supplemental in for uh a plan G. In the state of Minnesota, we're looking just over 300. So 320. Is that per or per person? Yeah, for a plan G. Okay. G's get a little expensive. Um I'm really a big fan of the Plan N equivalent in the state of Minnesota. Yeah, what's it? Because there are no excess charges charged in Minnesota. Okay. So really all you have to worry about is a $20 doctor's office visit and a $50 emergency room visit. So if we're looking for the Plan N, it's a significant difference. We're looking right around $175.

SPEAKER_05 21:37

All right. So $175 for an N plan. That would be each. Okay. Um that's that's $350. And with an in plan, uh what he is saying is that um uh in Minnesota, none of the docs uh can charge that excess. And that's one thing in does not cover. Now, if you were outside of Minnesota, there's a possibility, but the truth is we rarely see excess anyways. So I don't think it's a huge issue. I don't think it's a lot of risk. But so that'd be $175 each. We have to have a drug plan. And of course, without knowing what your meds are. Average drug plan right now is probably $20, $25. So the way I, if I were you, I'd look at it this way. It's going to cost us about $200 each. And again, drug plan is going to, you know, could bump that up a little bit, but $200 each to go ahead and go on Medicare and have a good, you know, good supplemental plan. And the nice thing about that plan, end plan, is the deductible this year is $283. So you have $283. You see a doctor, you have a $20 copay, emergency room, you got a $50 copay. So I think if you all are continually meeting that deductible, I mean that's high. That's a lot of money. So I think yeah, you're going to spend a little bit more every month, but you're going to have less out of pocket as the year goes on. Okay. Anything you want to add to that? Yeah.

SPEAKER_00 22:56

Yeah. I mean if you're meeting your deductible where you're at right now, I always take that into account plus your premium and kind of just do the math. You know, what is this a difference of you said $200?

SPEAKER_05 23:05

Yeah, he's only paying $200 a month, so he'd bump up to $400. Okay. So you pay $200 more a month, but uh your your deductible is drastically reduced. Exactly.

SPEAKER_00 23:14

That comes out to about $2,400 that you're spending a year in premium alone, where you're saving money on that deductible. And now you can see any doctor you like around the nation with a supplemental policy that actually accepts Medicare. Uh no referrals, no pre-approvals, so a lot more freedom as well, not to mention the lower deductible.

unknown 23:32

Yeah.

SPEAKER_01 23:32

Sure. Yeah. So I guess the essence of my question really is because the other possibility is to have my wife go on Medicare and I stay on butt. That means my premium shoots up, my premium for me and my daughter shoots up to twelve hundred a month. Um as we lose that benefit, the spouse-to-spouse benefit. Yeah, well. Um, and then I still have a $3,500 deductible. But we've also considered both going on Medicare and then trying to find an individual policy for our daughter. And we haven't gone too far into that possibility. Um but I guess the essence of the question is this is it just a dollar and cents decision? Because it feels a little more like that. And you know, we're just getting flooded with advertisements and mailers and and without, you know, and it does feel like everybody's trying to sell us something, which they are. We get that. That's understandable. It's not like we don't expect that, but we're trying to wade through that and make the wisest decision without just feeling, you know, feeling like we're being sold. Right.

SPEAKER_05 24:51

Well, Gene, let me let me let me let me interject here. Listen, I here's the issue for me. If your daughter's your daughter's 17, um I I would not want you to be in a position where you have to go out and try to find insurance for her. I I really would not. So if I were you, I I I would hold uh for this year, and then as you approach uh once you're eligible for uh Medicare the next year, and and as you you roll into that October time period, then that's when I would make the decision. I really would. I you're you're paying a couple hundred bucks a month. I know you got a lot out of pocket, but your daughter's on the plan to have to put her out there trying to find some insurance. And I know she's a low risk, she's 17, but you still want something for the same thing. Yeah, so it is not just dollars and cents. There's other factors contributing here. Her coverage for sure. Uh the the school not letting you go until October anyways, you know, as far as making that decision. So I I think you're sitting pr pretty well. I I would feel uncomfortable with you, especially with your daughter. Now, if your daughter wasn't part of the equation, then I think it is a little bit of an easier decision. So I would just suggest uh make it sometime next year as you approach October uh during the open enrollment season of you know of the company plan. Okay. That's what I would defer if it were me. Any anything you want to add easily? What's your opinion?

SPEAKER_00 26:10

Yeah, I would I would agree. Um it's never fun shopping the marketplace for insurance, Jim, as you probably know if you've kind of delved through. Yeah.

SPEAKER_01 26:17

Um but something of that. Oh, yeah. We've had a lot of differing opinions. We've talked to a few people, you know, because we're getting bombarded with stuff. And it's like uh information overload, paralysis by analysis. That's right. Um that's right.

SPEAKER_05 26:37

Ethan had a comment here real quickly, Jim.

SPEAKER_00 26:39

And um as she's approaching the age of college, if your daughter does plan to go to college, there are some student options for insurance. Not sure what the price would be based off of the university, but as you're approaching that as well, that's something I would take into account. It's not just the marketplace that you look into, but also maybe college insurance plans, even health sharing.

SPEAKER_05 26:58

But that's what I would think. That sounds really good. And by the way, those people that are reaching out to you, if it's all Medicare, uh 90% of the time or more, they're gonna want they're trying to get you on an advantage point. Right. And Jim, I would tell you, I I I I just wouldn't do that. If you have the funds to pay a little extra to get great insurance long term, you are gonna be happy. Uh these advantage plans, they you know, they they package them as though uh the insurance companies are you know being real benevolent trying to give you all this free stuff. Well, the fact is, uh yeah, they'll give you a few free stuff, but uh to get an MRI, it's gonna have to be pre-approved. To get a skilled nursing day, it's pre-approved. So I I wouldn't want the hassles that advantage plans put people through. Uh we write them because sometimes people just don't have the funds to really afford a submetal plan. Uh but these companies that are right now me reaching out to you, I'll guarantee you they just want to get you enrolled in advantage plan. So they'll package it and say whatever they have to to get your business. So just beware of that, sir. Okay.

SPEAKER_01 27:55

Okay. All right. Cool. All right. Good. I appreciate that.

SPEAKER_05 27:58

Yeah. Well, listen, we enjoyed talking to you. We've got one more caller we're going to get to before our program's over today. So if you don't have anything else, we're going to let you go and stay in touch as you approach these decisions. We'd love to serve as your broker, sir.

SPEAKER_01 28:10

Okay. Okay.

SPEAKER_05 28:12

Thank you. You take care now. See ya. You're welcome. All right, Eric. Great talking to you, sir. How can we be of help to you?

SPEAKER_03 28:19

When you're employed, you have an open season every year. I picked that. I always had uh blue cost, blue shield standard, and federal standard, and that was great on single. Covers everywhere in this area. Uh when I switched it to secondary, the premiums were the same. Like almost 500 bucks.

SPEAKER_05 28:44

I know. You would think they'd lower those, you know it? I mean, they're so l less out of pocket, but they keep it the same. That's that's a bummer. Those insurance companies don't want to give up that premium.

SPEAKER_03 28:56

I I and apparently some of the options, they'll actually pay part of your Part B. Because they like on secondary.

SPEAKER_05 29:09

Yeah, who who do you have, by the way? Do you have Blue Cross? Do you have Geehaw, Aetna? Who who are you with right now with the FEHB? Blue Cross. Okay, do you have Blue Cross basically?

SPEAKER_03 29:20

Federal employee right now.

SPEAKER_05 29:21

Yeah, is it is it okay? All right, keep going, sir.

SPEAKER_03 29:25

Um, and I have a and I got y'all delighted to do the one last switch. I I'm just and and trying to figure out if there's some advan, like I've heard you before, you know, if you're tri-care, you just say tri-care. Basically, but but and they and you know, you still have an open season every year, but I'm trying to figure out if there's any advantage, like you do I still have to do medical underwriting. Well, not really. Let's do that I I will tell you I I have I spoke with one of your counselors and I'm speaking with her to this afternoon. So good. She did all that research, found one for like a hundred some bucks. And then I gave her all my medicines.

SPEAKER_05 30:24

And what was she recommending on that part D plan? What what D plan was it? Did she tell you?

SPEAKER_03 30:31

Uh she did, but I don't remember.

SPEAKER_05 30:33

And that's fine. No problem. It'll be in our records. It's all right. Can you can you can you look him up in in HubSpot and C? Yes. Okay. Yeah, and and I'm glad you spoke with somebody. Uh were you leaning, as you all had that discussion, were you leaning towards a summonal plan G or Seminole Plan N? A G. A G. Okay, that sounds good. That's what that's what I have. Can you see those rates? Yeah, I got the rates up. Okay, just so I can we can get our minds around it. Go ahead. What's what what does he have on that G? Just ballpark.

SPEAKER_00 31:02

So a G, um on the lower end about 165 a month. Upwards of maybe 210.

SPEAKER_05 31:08

Okay, very good. All right. So she'll go all the with you, you know, your call this afternoon. And then uh drug plan, what was recommended? Yeah, we're trying to see if it's saved. We're going back to records.

SPEAKER_03 31:21

I paid everything for like 19 bucks a month or something.

SPEAKER_05 31:25

Okay.

SPEAKER_03 31:26

Okay. The same CPS drugstore.

SPEAKER_05 31:29

Okay. Yeah. Do you do you take very many, very many meds? Don't have any. Yeah, a fair amount. Okay, nothing. Okay. All right. Okay. Uh so let's go through this together. Uh yeah, I I think you're I think you're really overpaying, and I think you're gonna be overpaying for a real long time. So uh if you can get a med sub plan that $165 to you know $200 range, uh because that's three a year.

SPEAKER_03 31:55

Yeah, exactly. Right.

SPEAKER_05 31:56

You you know, you got a drug plan that you're gonna have, but i you're saying it's it would be in the teens. I'm on a drug plan right now, it's nine dollars and sixty cents a month. That same plan all over the country, zero premium. So it does vary state to state. But I can see no reason at all. I I just can't. Um you know, you're you're you of course you have to pay your full uh B premium, 2029, how Blue Cross Blue Shield, they're giving you about $800 a year credit, probably. So you're gonna lose that. But goodness, you're you're you're just paying too much. It's uh you're gonna save you know probably $250 at least every single month, and you're gonna have great coverage. Uh so that's what I would do. Now I want to mention something. There is a form uh that you would have to fill out if you decide to go this direction, that uh you would have to get to um uh OPM and let them know that you are actually dropping your FEHB. I don't uh uh the form is you know go Google that real quickly. It's real easy to find, but I I I always forget the form number on that, but it's um OPM to drop uh uh uh you know health care benefits. Anyway, so there's a form. You do have to fill that out uh and get get that to them. Otherwise they're gonna keep deducting that 550 out of your annuity check. So you don't want that to happen. Um but I would tell you you you do somewhat have some time constraints because without underwriting, we got February, March, April, May, June, July. So you do need to at least be deciding no later than the end of July for sure for an August 1, but you can still do it this month. There's no underwriting, you'll get approved. She can get you into a drug plan as well. So it would really be really pretty seamless. What is that form? Is there a number on it?

SPEAKER_00 33:30

Yeah, it says the OPM form is RI 79-9. All right, good. It's an alternative for 2809.

SPEAKER_05 33:38

20. Okay, very good. So just be sure you do that. I I had a guy several years back that uh we did just what you you were doing, he forgot to submit the form. And you you find out real quickly uh you that your annuity uh payment's not going to go down until you do that.

SPEAKER_03 33:52

So be sure to submit. And unfortunately, I've had a recent I can uh it's very hard to type and manage computer stuff. Yeah. Well getting all the agencies to figure out that oh my uh VHB is now secondary forever. Yeah, yeah, yeah. It can so but there's no hidden government benefit that oh, it's you can re-look at uh plans every year and not be subject to medical underwriting.

SPEAKER_05 34:35

No, no, now Virginia, I think Virginia just just uh passed a birthday rule. I'm pretty sure they did. Yeah. So what'll happen is you will get that, you know, you're gonna come off the the you know OPM involvement anyways, any government involvement. But in the state of Virginia, they do have a birthday rule, so each year you can reevaluate to see if you still are on the best plan. And as your broker, we'll we'll help uh help you with that to you know to stay up to date. Uh so whatever agent you worked with in our company, they're part of a pod, and there's a uh contact manager. We we we that's the way we kind of keep things organized to make sure our clients not only are taken care of initially, but long term as well. So we'll help you with that as uh as time goes on. Okay.

SPEAKER_03 35:18

Okay. Well, that helped me make my decision. The research is already done.

unknown 35:23

Yeah.

SPEAKER_03 35:25

Yeah. Uh need to file it by the end of this month, or it's gotta be done by the end of I need to.

SPEAKER_05 35:31

I will if you're deciding, if you decide you want to start that supplemental plan, effective seven one, I'd be getting that in. Uh ASAP. And if you want to put it off to 8-1, that's fine. Um I probably wouldn't. That's kind of a waste of money. Uh but you're fine either way. Just not beyond 8-1 start date. Okay.

SPEAKER_03 35:49

I think you okay.

SPEAKER_05 35:51

I want to thank you for calling in today and uh giving us uh a privilege to serve as your broker, sir.

SPEAKER_03 35:56

Thanks so much for the help. Um you guys explain the clearest.

SPEAKER_05 36:02

Well, I hope you enjoyed today's program. I certainly did. I thought we had some great callers and looking forward to having you tomorrow. Let me tell you what we're gonna be discussing then. We're gonna talk about the Social Security break-even point. Uh, this breakeven point is important for all people because it helps you determine the right time for you to take Social Security. So we'll be covering that in uh detail tomorrow.